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Membership Form

Calendar year, Jan 1 – Dec 31

Use the form below to apply for membership or to renew your membership for next year. After you submit this form you'll be given instructions on how to send in your dues with a check or you can pay online via Paypal.

Membership Type *

Standard Membership ($30)

Junior/U23 Membership (no fee)

First Name *

Last Name *

Country *

Address 1 *

Address 2

City *

State *

ZIP Code *

Phone Number *

Email *

Emergency Contact Name *

Emergency Contact Phone Number *

USA Cycling License# (if applicable)

Your licensed category(s)

Road

Mountain

Cyclocross

USAC Official

Main Cycling Interests *

Road

Mountain

Triathlon

Cyclocross

All members who will be seeking reimbursement for events are required to choose and volunteer their time in a minimum of 3 club-recognized, community activities or sponsored events, as well as choose and actively serve on a committee. Below are committees/activities needing volunteers. Please indicate which you may be able to help with.

Road Race/Omnium Committee

Criterium Series Committee

Time Trial Series Committee

Mtn. Bike Race Committee

Cyclocross Committee

Community Events Committee

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